Parent-adolescent dyads: association of parental autonomy support and parent-adolescent shared diabetes care responsibility.

PURPOSE: Parent-adolescent shared responsibility for diabetes care is advocated by experts to achieve beneficial diabetes and psychosocial outcomes for adolescents with type 1 diabetes. Parental autonomy support may be a way to facilitate this sharing. In this dyadic study, we examined parental diabetes-specific autonomy support experienced by adolescents with type 1 diabetes and their parents (n = 89 dyads), and its association with their experience of shared diabetes care responsibility. METHODS: Path analysis was used to test an Actor-Partner Interdependence Model for parental autonomy support effects on shared responsibility. This was a secondary analysis of data from 89 parent-early/mid-adolescent dyads. RESULTS: Actor effects were identified. Parents' and adolescents' perceptions of parental autonomy support were associated with their respective reports of shared diabetes care responsibility. One partner effect was identified. Adolescents' reports of parental autonomy support were associated with parents' reports of shared responsibility. Parents and adolescents held similar views of autonomy support but discrepant views of shared responsibility. Older adolescents perceived less parental autonomy support. CONCLUSION: Increasing parental autonomy support may facilitate parent-adolescent sharing of diabetes care responsibility. Adolescent and parent perceptions influence each other and need to be considered when working with them to strengthen parental autonomy support.

Parenting, autonomy and self-care of adolescents with Type 1 diabetes.

BACKGROUND: During adolescence diabetes creates a juncture of very complex disease management demands with developmental needs, including the striving of adolescents for greater autonomy. Parents' concerns and fears about the teen's diabetes self-management abilities during this time can heighten parental attachment behaviour and affect the parents' ability to support autonomy development necessary for effective self-care. Maternal parenting processes may be especially important for those adolescents who have Type 1 diabetes because mothers are the primary caregivers. PURPOSE: Based on attachment theory, the aim was to test a model of the influence of mother-adolescent developmental conflict, maternal separation anxiety and maternal inhibition of autonomy and relatedness on cognitive autonomy and self-care of adolescents with Type 1 diabetes. METHOD: A total of 131 families with an adolescent, aged 11-15 years, contributed data annually across three waves. Mothers and adolescents completed paper-and-pencil measures and two interaction scenarios that were coded by trained staff from audio-tapes. The adolescent also completed a structured interview and questionnaire to assess self-care. RESULTS: Maternal separation anxiety when adolescents were 11-15 years of age directly predicted cognitive autonomy at 1-year follow-up, and that cognitive autonomy was directly related to self-care 1 year later, but did not mediate between separation anxiety and self-care. CONCLUSIONS: Future investigation of the influence of separation anxiety of parents on adolescent autonomy development is warranted, as well as the contribution of autonomy development to diabetes self-management behaviours of adolescents.

Data collection with adolescents.

Adolescence spans a wide time period during which development and its context influence behaviour and the strategies used for data collection. This article addresses problems that can be anticipated in data collection with adolescents. Problems are presented that are associated with adolescent developmental capacities, adolescent developmental change and stability, gender and ethnicity. Some problems are specific to certain settings or to certain data collection methods. The application of theoretical and empirical knowledge about adolescent development can strengthen data collection instruments and procedures. Strategies to enhance data collection include carefully defining adolescence and tailoring procedures and protocols based on a theoretical understanding of the biological, cognitive and emotional development of adolescents in conjunction with an understanding of the characteristics of the research setting. Adolescent research settings can pose challenges. Investigators must understand clinic routines in evaluating the feasibility of implementing protocols and collecting data where there are distractions and time constraints. In education settings, strategies must be used to collect data in a group context where peer pressure can affect responses. In home settings, ingrained response patterns and family norms can also impede obtaining valid perspectives from adolescents. Ethnicity as well may play an important role that must be addressed when designing and implementing data collection with adolescents. Procedures and instruments selected to collect data need to address variations in ethnicity.

Menstrual attitudes among black and white premenarcheal girls.

PROBLEM: To determine if a difference exists between black and white fifth-grade girls' attitudes about menarche and menstruation. METHODS: The Menstrual Attitude Questionnaire-Adolescent Form (Brooks-Gunn & Ruble, 1980) was used to collect data from 55 premenarcheal females, ages 10-12 years. FINDINGS: The findings indicated no difference between black and white girls in Affirmation or Worry. Like older samples, the girls were moderate in affirmation. Unlike older samples, they evidenced less worry. CONCLUSION: Analysis of the instrument used in this study raises questions in general regarding its use as originally developed. In addition, specific questions were raised about its use with different cultural groups.

Understanding separation anxiety disorder.

BACKGROUND: When children are acutely ill and life is threatened, separation anxiety can develop in parents and children. Separation anxiety has been studied through two traditions--as a normative phenomenon and as a disorder. SOURCE: A comprehensive review of the literature. OBJECTIVE: To analyze and evaluate the literature to derive clinical and research implications. CONCLUSIONS: Support was found for the development of interventions beyond the developmental stage of early childhood. The need for a family approach was evident.

Decision points in choosing family self-report scales in research.

Literature that systematically highlights critical decision-making points in conducting family research is sparse. The wide-spread use of self-report instruments in family research suggests that explication of decision-making points involved in the use of self-report instruments is needed. A specific instrument, the Family Environment Scale (Moos & Moos, 1986), is used to illustrate relevant decision-making. Conceptualization of a study, instrumentation, and data analysis are addressed.

Parents' perceptions of diabetes in adolescent daughters and its impact on the family.

Parent's perceptions of diabetes in adolescent daughters and its impact on the family was examined. Transitions in health and developmental state affect the experience of families and the ability to make needed adjustments. Adjustments in the parental subsystem are required at adolescence to promote increased independence. Qualitative content analysis of semistructured parent interviews showed that the daughter's diabetes was perceived to draw the whole family closer together while negatively affecting the spousal relationship. Episodes of poor diabetic control were experienced or anticipated in relation to adolescence. Suffering emotional distress was a central process related to parental concerns about diabetic control.

Self-care capabilities in black girls in anticipation of menarche.

Limited research exists on young girls' expectations of self-care related to menarche. No studies specifically focus on black girls. This study describes the self-care agency of a group of black premenarcheal girls with respect to menarche. Data were collected through audiotaped interviews from a standardized schedule of questions based on Orem's theory. A verified content analysis was conducted. Family system elements, sociocultural orientation, peers, and developmental state were determined to be important in conditioning the self-care agency in preparation for menarche. Girls had difficulty estimating what self-care should take place although there was some ability to acquire and retain knowledge from an authoritative and personal source. Menarche was viewed as an event involving self-care in the areas of two requisites: elimination and social interaction.

Marital strife, social support, and the development of mentally retarded toddlers.

The birth of a mentally retarded child is a stressful experience for the family. Research exploring the differences between these families based on the child's developmental competence is sparse. This study examined marital strife and social support within two groups of retarded toddlers. Data were collected through observation, an interview, and questionnaires. The focus of marital agreement and disagreement differed between the groups, as did social support. However, birth order and family life cycle stage were found to be important confounding variables.

Education for menarche.

Educational programs to prepare young women for menarche potentially can affect their self-view, peer interaction, decision-making, and self-care capabilities. A review of literature on menarche and menarcheal education is presented with implications for program development. References that can assist health educators in developing appropriate content and strategies are identified.